To detect potentially harmful errors before they affect patients, hospitals require an independent double-check (IDC) be performed whenever a nurse is administering a complex medication to an inpatient. A second set of eyes must check each component of the work process, from the type of medication being given, to the calculations used for dosage and the equipment being used to administer the drug (ensuring, for example, an IV pump is programmed with the correct drip rate and time). According to the Institute for Safe Medication Practices (ISMP), numerous studies have demonstrated this practice detects up to 95% of errors before they occur.
IDCs Are Time-Consuming
But the ISMP is first to admit that, as a risk-reduction strategy, it can be a source of stress for busy nurses who are short on time. “At certain times of day, when the volume of patients who require medication administration is high, it can be very challenging to find a nurse to assist with this task,” explained Sara Gibbons, MSN, RN-BC, CPN, director of quality and professional practice at Boston Children’s Hospital (BCH). “Especially if the nurse has to ‘suit up’ because your patient is on precautions.”
So Gibbons and three of her colleagues – Stephanie Altavilla, MSMI, RN, Jennifer Taylor, MSEd, BSN, RN-BC, CPN, and Jowell Sabino, MSN, RN – brainstormed ideas to improve the efficiency and effectiveness of the process.
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Using a grant from the hospital’s Innovation Acceleration Program’s FastTrack Innovation in Technology Program, the four nurses researched and developed a prototyped mobile system for IDCs called RNSafe.
IN THE BUNKER: Sara Gibbons, MSN, RN-BC, CPN, director of quality and professional practice at Boston Children’s Hospital, performs a remote independent double-check using RNSafe. (Photo courtesy Boston Children’s Hospital)
In the Bunker
The idea behind RNSafe is similar to that of an electronic ICU (eICU) model in which off-site ICU specialists can monitor a patient’s data from a remote location. It utilizes live video chats which take place between the nurse in the patient’s room and a bunker nurse.
“We plan to have one nurse dedicated to the task of ‘manning the bunker’ and performing IDCs,” Gibbons related. “The bunker nurse within will be isolated from others, free of distractions, and totally focused on double-checking these high-risk medications.”
The process begins when the nurse at the bedside enters a request for an IDC from the patient’s electronic health record, and the bunker nurse responds. Using any type of smartphone or an iPod Touch, the bedside nurse can point the camera at the label of the medication they are giving, show the dose they’ve measured out, and then move on to show the details on any of the special equipment used to administer the medicine.
“Most nurses will be using their own smartphone for this,” Gibbons said.
The bunker nurse views all this video on a tablet and directly video chats with the nurse at the patient’s bedside. The entire process is documented on a dashboard within RNSafe.
Implementation on the Horizon
In the beta testing phase, the RNSafe videochatting proved to be high-resolution enough to verify the smallest details, such as the font on a medication label or the dose measured out in a syringe, in a variety of different settings and lighting conditions. The four RNSafe innovators are taking turns “manning the bunker” during this phase of testing.
Next, the group will roll out a pilot project in one department of the hospital. “It won’t involve patients initially, as we will be training the nurses on how to use the system,” Gibbons noted. “But hopefully, it will be ready to implement soon. And it should definitely improve efficiency with respect to IDCs.”
Anne Collins is on staff at ADVANCE. Contact: firstname.lastname@example.org